Coverage Review Pharmacist

Location: Remote within the United States, Tennessee, Chattanooga

Company

hirify.global is a health insurance organization providing coverage and pharmacy-related services.

What you will do

• Perform prospective and retrospective coverage reviews and appeals in accordance with state and federal regulations.
• Provide clinical support for basic to mid-level reviews with limited supervision.
• Maintain denial rationales based on clinical criteria.
• Ensure decision letters comply with regulatory requirements and guidance.
• Participate in an alternating team on-call rotation.

Requirements

• Doctor of Pharmacy (PharmD) degree.
• Three years of clinical experience, or completion of a one-year residency and/or board certification.
• Licensed in Tennessee to practice pharmacy, or eligible to obtain Tennessee licensure within 120 days of employment.
• Competency in compendia navigation and research.
• Proficiency in Microsoft Office, including Outlook, Word, Excel, and PowerPoint.
• Knowledge of medical and pharmacy products and regulatory guidelines including FDA, NCQA, EQRO, and CMS.

Culture & Benefits

• Full-time employee position.
• Work independently with minimal supervision or collaborate in a team environment with shared accountability.
• Manage multiple projects using strong organizational and communication skills.
• Participate in a rotating on-call schedule.